Embedding Restorative Justice in the NHS: From Blame to Healing
The National Health Service (NHS) is one of the UK’s most trusted and essential institutions, delivering care to millions every year. But beneath its proud legacy lies a set of systemic challenges: staff burnout, low morale, rising complaints, and a culture that has at times defaulted to blame rather than understanding. In an environment where mistakes can be fatal and pressure is constant, it’s understandable that a risk-averse, hierarchical system has developed. Yet this very structure can sometimes undermine the compassionate ethos at the heart of healthcare. Restorative justice offers a different way forward—one that centres on healing, responsibility, and dialogue.
Restorative justice is traditionally associated with the criminal justice system, but in recent years it has found applications in schools, communities, and large organisations. At its core, it is a philosophy and a set of practices focused on repairing harm, rather than punishing it. In healthcare, this means moving beyond individual blame when things go wrong and instead asking: what happened, who was affected, and how can we make things right? Embedding restorative justice into the NHS could transform not just how conflicts are managed, but how care is delivered, relationships are nurtured, and trust is built—between staff, patients, and the public.
The Foundations of a Restorative Culture
For any large organisation to successfully embed a restorative culture, it must begin with clear foundational principles. These principles are neither abstract ideals nor optional extras—they are practical commitments that inform everything from everyday conversations to top-level decisions.
First, leadership must lead by example. A restorative culture cannot flourish if leaders continue to operate within traditional command-and-control frameworks. Instead, leaders need to model vulnerability, transparency, and empathy. They must be willing to admit mistakes, invite feedback, and facilitate open dialogue even in moments of crisis. This means shifting from being controllers of risk to being stewards of relationships.
Second, engagement needs to be wide and inclusive. Staff at all levels—from consultants and managers to porters and receptionists—must have a voice in how restorative approaches are introduced and developed. The culture of a hospital or clinic is not set by policy documents but by the day-to-day interactions of the people who work there. Everyone must feel that they are not only invited into the process but that their experience and insight genuinely shape it.
Third, restorative justice must be embedded into the system, not bolted on. Too often, well-intentioned initiatives falter because they are treated as projects rather than culture change. This requires integrating restorative principles into existing structures—such as HR procedures, patient complaints processes, patient safety and clinical governance frameworks—so that they become part of how the NHS works, not a separate activity that sits alongside it.
Finally, learning must be continuous. A restorative NHS will not get everything right the first time. There will be missteps, resistance, and unanticipated consequences. But if the system encourages feedback, reflection, and adaptation, it will evolve in the right direction. Restorative justice is not a fixed destination—it is a way of thinking and being that deepens over time.
Understanding the Need: The Cultural Landscape of the NHS
The case for restorative justice in the NHS is not theoretical—it is grounded in the lived realities of healthcare workers and patients. Reports like the Francis Inquiry (2013) and the Ockenden Review (2022) have highlighted tragic failures in care, often linked to cultures of fear, denial, and deflection. When staff feel unsafe to speak up, and when patients are treated as problems rather than partners, the consequences can be devastating.
At the same time, the NHS workforce is under extraordinary strain. Chronic understaffing, high vacancy rates, and increased demand have created an environment in which many professionals are simply trying to survive each shift. In such conditions, the emotional toll can be immense. A restorative approach doesn’t just address what happens after something goes wrong—it proactively builds resilience in a culture of psychological safety, where people feel supported, seen, included and valued.
Patients and families increasingly expect healthcare to be not only clinically effective but emotionally intelligent. When care fails, they want answers—but they also want honesty, connection, and for the impacts on them to be addressed, as well as a sense that lessons will be learned. Restorative processes offer a structured way to meet these needs without defaulting to defensiveness or litigation.
Step-by-Step: Implementing Restorative Justice in Practice
Implementing restorative justice in the NHS is a complex undertaking, but it becomes manageable when broken down into clear, actionable steps.
The first step is to assess the current organisational culture. This involves listening—deeply and systematically—to the experiences of staff and patients. Qualitative methods such as confidential interviews, anonymous surveys, and facilitated focus groups can uncover patterns of fear, silencing, or disengagement that quantitative metrics often miss. This diagnostic phase is critical because it provides a baseline and ensures that restorative interventions are tailored to real needs rather than imposed assumptions.
Once the landscape is understood, the next step is to develop a clear, shared vision for what restorative practice looks like in the NHS context. This vision should be co-created with staff and stakeholders, not dictated from the top. It should answer questions like: How do we respond when harm occurs? What do accountability and responsibility taking mean in our setting? How do we repair trust after a breakdown? By defining these concepts collaboratively, the organisation lays a foundation that is both meaningful and actionable.
With the vision in place, attention turns to capability-building. Training is essential, but it must go beyond a few workshops or one-off seminars. Ideally, restorative training should be embedded into induction programs, leadership development pathways, and continuing professional development. All staff should learn practical skills such as active listening, nonviolent communication, and circle facilitation. Staff who respond to harm or conflict should learn how to facilitate restorative enquiry and dialogue. Leaders need support in how to manage conflict restoratively, how to model restorative values, and how to resist the instinct to control outcomes.
As training is rolled out, organisational policies and procedures must be reviewed and revised to reflect restorative principles. This may involve reimagining disciplinary processes so that they focus on understanding context and repairing harm rather than assigning blame and proportionate sanction. It might mean adapting incident investigation frameworks to include facilitated dialogue between those most affected. It certainly means ensuring that patients have meaningful routes to participate in shaping accountability and learning when things go wrong.
Throughout this process, it’s vital to monitor progress. This doesn’t just mean counting how many people attended training or how many restorative meetings were held. It means tracking the real-world impact: Are staff feeling more heard and supported? Are patients more satisfied with how their needs are responded to? Are teams functioning more cohesively? Mixed methods evaluation—combining stories with statistics—is often the most powerful way to measure cultural change.
Practical Applications in Daily NHS Work
Restorative justice is not just a strategy for dealing with harm or conflict. It has everyday applications that can improve working relationships, support better decision-making, and enhance patient care.
One clear area for application is in responding to adverse events. Traditionally, when something goes wrong—whether it’s a medication error or a communication breakdown—the process that follows is often legalistic, adversarial, and siloed. A restorative response invites all those involved to come together in a structured, facilitated conversation. The aim is to understand what happened, explore the impact, acknowledge responsibility, and agree on steps to both repair and learn. Research shows that such approaches can significantly reduce the emotional toll on staff while increasing trust and satisfaction among patients and families.
Restorative practices can also be used to strengthen staff relationships. In high-pressure environments, misunderstandings and tensions are inevitable. Instead of allowing these to fester or escalate into formal grievances, restorative conversations can help people surface concerns, hear each other’s perspectives, and rebuild mutual respect. Some NHS trusts have begun training peer facilitators who can support such conversations informally, before conflict hardens into entrenched opposition.
Patient engagement is another vital area. When patients feel that their needs are dismissed or minimised, they may withdraw, complain, or even take legal action. A restorative approach involves genuinely listening to patients—not just through satisfaction surveys but through ongoing, relational engagement. For instance, involving patients in service redesign or inviting them to restorative circles after incidents can foster co-production, reduce defensiveness, and rebuild trust.
Looking Ahead: The Long-Term Promise of a Restorative NHS
If the NHS were to fully embrace restorative justice, the potential long-term outcomes could be profound. At the interpersonal level, we would see more cohesive teams, less conflict escalation, and greater psychological safety. Staff would feel more connected to their purpose and more resilient in the face of challenges. Patients would experience a system that listens to them, learns from them, and treats them with dignity care and compassion—even when things go wrong.
At the systemic level, restorative practice could help shift the culture of the NHS from compliance to compassion. This doesn’t mean abandoning standards or accountability—it means redefining them in relational terms. True accountability is about standing in the discomfort of what happened, facing others affected, addressing harms and needs now and committing to do better in the future. In a restorative NHS, learning would not be reactive and piecemeal—it would be ongoing, embedded, and alive.
There are also economic implications. While restorative approaches require investment—in training, facilitation, and culture change—the long-term savings can be substantial. Reduced litigation, lower staff turnover, fewer grievances, and better patient outcomes all contribute to a healthier system. Furthermore, the intangible benefits—like morale, trust, and pride—are arguably just as important.
Culture Change is Possible
Embedding restorative justice into the NHS will not be easy. It demands time, humility, and courage. It requires letting go of old certainties and being willing to sit with complexity and contradiction. But the rewards are significant. In an era when healthcare workers are under pressure and patients are seeking more than just clinical interventions, restorative justice offers a way to reconnect with what healthcare is really about: relationships, care, and healing.
Cultural change in any large organisation is hard. It’s especially hard in the NHS, where the stakes are so high and the systems so entrenched. But it is not impossible. Pockets of restorative practice are already taking root across the service—in maternity units, mental health trusts, and professional training schemes. These early adopters are showing that another way is not only desirable but doable.
The question now is not whether restorative justice can work in the NHS. The question is whether we are ready to do the work to make it happen.
Authors:
Jim Simon - Chief Executive Officer, Restorative Justice Council
Joanne Hughes - Trustee, Restorative Justice Council and Founder, Restorative Lens